President Donald Trump Tuesday issued an executive order that bans federal support for gender-affirming care for Americans under the age of 19, his third executive order restricting the rights of transgender people since he took office last Monday.
The order, titled “Protecting Children From Chemical And Surgical Mutilation,” bans federal dollars from funding gender transition, including affirming counseling, puberty blockers, hormones, and rare surgical interventions, for children and 18-year old adults nationwide. The order asserts that this evidenced-based care, which is effective in preventing depression, anxiety, and suicide, and is supported by major medical organizations in the US and elsewhere, is “junk science” that cloaks “blatant harm done to children by chemical and surgical mutilation.”
The administration’s claims are not based in fact, and Trump’s order will likely prompt a lawsuit, or lawsuits, that may delay its implementation. (The Supreme Court of the United States is already considering the constitutionality of gender-affirming care bans in the Skrmetti case, which it is expected to rule on this year).
According to the order, by April 28, the new Health and Human Services Secretary (likely Robert F. Kennedy Jr., if approved by the Senate), shall use “all available methods to increase the quality of data to guide practices for improving the health of minors with gender dysphoria, rapid-onset gender dysphoria”—a disproven medical “contagion” myth that sprang from online anti-trans parents groups distressed with their child’s identity—“and other identity-based confusion.”
If Kennedy, a vaccine skeptic and peddler of hack medicine, is charged with this task, he will not conduct a real scientific evaluation because he is simply incapable of one. The administration is clearly not concerned with the quality of research or evidence anyhow, as the order also ensures both hospitals and research institutions that receive federal dollars “end the chemical and surgical mutilation of children.”
The order also directs the HHS to take other actions to end gender-affirming care for children and 18-year-old adults. To that end, the order suggests employing the conditions for participation in Medicare and Medicaid, the definitions of “clinical-abuse” and “inappropriate-use” as relevant to state Medicaid programs, and mandatory reviews of drugs used for gender-affirming care, which include medications regularly prescribed to cisgender children like puberty blockers.
The order also points HHS to the latest editions of the International Classification of Diseases and other federally funded manuals, which includes the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. While many consider it limited and reductive of trans experience, gender dysphoria, as defined in the DSM, is the basis on which all trans care is considered medically necessary. Transgender care specialists worldwide also rely on medical standards set by the World Professional Association for Transgender Health. The order directs the HHS to rescind or amend policies that rely on its guidance. It’s unclear who or what HHS will look to instead.
Importantly, the order directs the HHS to review section 1557 of the Affordable Care Act, a non-discrimination provision that protects transgender Americans’ right to gender-affirming care. It is unclear if the HHS review would result in an attempt to change that. (This too would likely prompt an immediate court challenge with multiple plaintiffs).
Outside of HHS, the order excludes trans kids from receiving gender-affirming care through their parents’ government-funded healthcare plans including Medicaid and the Department of Defense’s TRICARE for military families.
It also directs the Department of Justice, with the aid of State Attorneys General and other law enforcement agencies, to apply laws banning female genital mutilation to gender-affirming care. The DOJ is ordered to investigate any entity that may be “misleading the public about the long-term side-effects” of gender-affirming care under the Food, Drug, and Cosmetic Act, and challenge sanctuary state policies that protect trans children from abusive homes. The order suggests the DOJ apply a law against child kidnapping, which was one of the inflammatory accusations the right levied against a 2023 Washington law (SB5599), which expanded protections for child runaways seeking gender-affirming and reproductive care.
According to the order, the DOJ and Congress will jointly develop laws that make it easier for trans patients to sue their doctors for malpractice. Despite extremely low regret rates for gender-affirming care, state legislatures across the US have introduced similar bills. The specter of liability is meant to discourage doctors from practicing, a tactic developed by the anti-abortion crowd, who learned threatening doctors with punishment is more politically palatable than threatening patients.
This is the third order concerning transgender people Trump has issued in eight days. All use intense rhetoric and dehumanize trans people.
The first promised to “defend women” and “restore biological truth” to federal policy.
The second prioritized “military excellence” by suggesting trans people were the result of an ideology that had infected its ranks, asserting that the “adoption of a gender identity inconsistent with an individual’s sex conflicts with a soldier’s commitment to an honorable, truthful, and disciplined lifestyle, even in one’s personal life.”
This third order calls evidence-based medicine mutilation, and a “dangerous trend” that “will be a stain on our Nation’s [sic] history, and must end.”
This language, similar to the “criminal” and “illegal” epithets Trump uses for migrants, are not just racist or transphobic. They’re meant to trick the reader, or listener, into believing his government is not really infringing on the civil rights of “people,” by referring to them as abstract concepts and objects that are not entitled to rights. Therefore, no moral line could be crossed.
When trans people are reduced to “radical political theories and social experiments,” as Trump referred to them in his inaugural address last Monday, he intentionally obscures reality for the benefit of political spectacle.
Trans people in reality are not experiments, ideological, medical, or otherwise, but patients whose medical care is based in sound science and people who want basic legal recognition and equal treatment under the laws of this country, which, in reality, do not allow a president to rule like a king.
This is a developing story. Challenges to this executive order are likely.
djt’s gonna make America
Great Again even if it
Destroys us. which
it likely will. The
pain and agony
have Arrived
well
I should
Say for Most
of Us. others’ve
had the Jackboot on
their Necks for — how old are we?
Reading McCall’s summary of the executive order, I thought, “Gee, setting aside the constitutional issues of equal protection and due process, I don’t think the president has statutory authority to do this.”
But having now read the text of the order on the White House webpage, I’m convinced the president does have statutory authority. The meaty parts of the order do not directly defund pediatric trans care but rather order the pediatric healthcare-involved agencies (mainly CMS and TRICARE) to take regulatory and sub-regulatory action to get them out of the pediatric trans care business. That’s certainly within the president’s and agencies’ statutory authority, provided they march through the APA process. So that only leaves the constitutional questions as a potential bar to this order.
Just as we all feared, Trump 2.0 is much savvier and better-organized than Trump 1.0. Some of this stuff is likely to stick.
This is just the start, the far right is going to be up in your business with morality laws. Gay marriage isn’t far behind
@5
Yup, we’ll be married filing separately soon.
It’s a great time to be a federal lawyer, with all the lawsuits now and in the near future. I expect to need a lawyer shortly. If you make $20 million per year it’s great for you, but will suck for everyone else.
Oops was for @4
(need 1more cup of coffee)
“Despite extremely low regret rates for gender-affirming care”
Really? I’m always amazed Viv at your cavalier way of quantifying human suffering into a guessed percentage pulled out of thin air. Is it one, a hundred, ten thousand? We don’t know. And until we know, you don’t know.
Indeed there are people who do regret and are detransitioning and others who may not regret but have chronic and painful medical ramifications they will deal with for the rest of their lives – even if they had a great surgeon. And you know that. Yes it’s a subset, but can you think of any other area of medicine where people who have a bad time with it are treated so poorly and shunned?
It’s one thing to address transitioning as a treatment for the pathology of gender dysphoria, but it’s gotten far more than that. We’re in an era where kids are more stressed out and depressed than ever. Much of it is due to social media and smartphones. There are kids who have used transitioning because it’s seen as an escape to life’s pain that has nothing to do with gender dysphoria but it might be something else, depression mostly, also very often dispair from sexual abuse. Autistic children are vulnerable to such influences. The gender ideology promoted in our elementary schools is dangerous. Rather than a remedy for a very rare condition, our schools are promoting transgenderism as an alternative option for life, a cosmic off-ramp if you will, so you don’t have to face the turbulent years of adolescence in search of one’s inner self. This is why we must reserve childhood as a time when mistakes are not permanent by preventing them from making life altering consequences they’re way too young to fully understand.
Of paramount importance is for gay boys and lesbian girls to go through puberty to ascertain their sexuality without influence that they might be trans. Yes, there are parents who would prefer a daughter to a gay son. This is the worst, and most chilling, homophobia.
The facts are that the science is not settled. WPATH stats are a joke. Endocrinological ramifications continue to be unearthed. Malpractice insurance for gender care doctors is getting difficult. Ask any transgender person who has gone through reassignment surgeries if they think you need to be absolutely sure, and they say 1000% yes. So why the rush? We all know kids can be fickle. We were. So there’s no harm in holding off until adulthood. Trans joy is real – but it’s for mature adults who know they need it, not for kids exploring options to quell their psychic pain.
I haven’t studied the order fully but this is good news.
@4 – Well, it won’t be in this administration as we have a married gay treasury secretary.
@7 hey thin air has a website! How lucky for us.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/
“A total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS, were included. The pooled prevalence of regret after GAS was 1%”
“Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS.”
Anyway, continue your unqualified/baseless postulations and speculations.
More trans people regret delaying their transition than those who regret transitioning at all. There is no such thing as a regret-free elective medical care but gender transition has lower rates of regret than any other procedure you can name. The care is deliberate and incremental and everything short of surgery is reversible anyway. If you or your child are not trans none of this is any of your fucking business.
None of this is about protecting kids. They are using trans people as a wedge issue and a distraction while they do everything they can to trample on the constitution and our democracy and there are way too many ignorant people and outright bigots who fall for this shit.
Hey Dale, that study you linked to focuses on adult transitioners and Trumps EO is for youth. Some of the studies at least have decent follow up times, but just over 25% had no follow up time frames listed. I think the older people are when they transition, the more likely they to have a better understanding of themselves.
And it looks like there are more non-medicalized trans youth than there are medicalized, if that’s correct then this doesn’t directly impact most trans identifying youth directly.
If the regret rates are really as low as Vivian states then the Doctor’s and medical institutions don’t have much to worry about with the expanded liability that this EO puts them under.
I would have rather had this work it way through the courts under a Harris administration.
@10 That’s because there aren’t ANY children having actual sex change operations to study. It’s not a thing that actually happens. There are no people at schools chopping off kids weiners no matter how much Trump and his goons want you to believe there are. The nurses can’t even give a kid a baby aspirin without calling their parents. Good lord.
@7 Nobody is trying to give children sex changes. Gender affirming care can be as simply as having a doctor or psychiatrist to discuss their feelings with. And if it gets as far as puberty blockers, they’re reversible if the kid changes their mind. You know… completely unlike my circumcision which I had absolutely zero say in.
@7, The belief that this administration won’t fuck over gay people because he has a gay secretary of whatever is the kind of shallow, credulous thinking that helped bring him back to power in the first place. Trump is also buddies with Caitlyn Jenner yet that hasn’t stopped him from trampling all over her dignity, assuming she has any. LGBTQ rights are of no consequence to you anyway so if you could kindly keep my community’s name out of your glib, ignorant mouth when you’re rationalizing his authoritarianism it would be greatly appreciated.
Sure, several American medical associations still agree with the underlying premise of “gender affirming care” but the UK says it’s not medically necessary care and it causes more harm than good. Other European nations have similarly halted care for under-18s. Seems like we should proceed with the utmost caution and keep the hippocratic oath to do no harm in mind. Watchful waiting and counseling should be the treatment modality until adulthood.
@14 literally none of what you said is true beyond the american medical establishment recognizing that gender affirming care is safe and effective
@15 – I said they bought into the premise. I did not say such care was safe or effective. Please let me speak for myself. Thanks!
@11
Lots of trans adults don’t get sex change operations, are you saying that they are somehow not trans?
16 i don’t care what some random idiot on the internet thinks about medicine and i didn’t imply anything about your stupid opinions beyond pointing out that they’re based on a bunch of bullshit you pulled out of your ass
@12 I don’t think talking to a therapist counts as “gender affirming care” by anyone’s definition. No one is going to be denied access to therapy due to this.
Misguided as I’m sure the right is on this topic, they DO think that children are being given sex changes and / or drugs that can do irreversible damage, and are trying to act with good intentions. This has nothing to do with eventually reversing gay marriage rights.
It seems that the correct tactic would be to get them accurate information so everyone can get on the same page. If children aren’t getting sex changes (and last I checked, children weren’t even allowed to get tattoos), then we should be able to do that. Though I doubt that will happen, since neither side seems interested in actually listening to the other.
@9: “everything short of surgery is reversible anyway”
Not true
@9 “If you or your child are not trans none of this is any of your fucking business.”
Surprise surprise! Let’s silence people who disagree with us by ‘gatekeeping’ who may when and what about. Typical lefty move, playbook 101.
Correction: “who may speak when, and what about”